Article Text

Original article
Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study
  1. Else-Mariëtte B van Heijningen1,
  2. Iris Lansdorp-Vogelaar1,
  3. Ewout W Steyerberg1,
  4. S Lucas Goede1,
  5. Evelien Dekker2,
  6. Wilco Lesterhuis3,4,
  7. Frank ter Borg5,
  8. Juda Vecht6,
  9. Pieter Spoelstra7,
  10. Leopold Engels8,
  11. Clemens J M Bolwerk9,
  12. Robin Timmer10,
  13. Jan H Kleibeuker11,
  14. Jan J Koornstra11,
  15. Harry J de Koning1,
  16. Ernst J Kuipers3,12,
  17. Marjolein van Ballegooijen1
  1. 1Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
  2. 2Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
  3. 3Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
  4. 4Department of Gastroenterology, Albert Schweitzer hospital, Dordrecht, the Netherlands
  5. 5Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, the Netherlands
  6. 6Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands
  7. 7Department of Gastroenterology and Hepatology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
  8. 8Department of Gastroenterology and Hepatology, Orbis Medical Centre, Sittard, the Netherlands
  9. 9Department of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands
  10. 10Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
  11. 11Department of Gastroenterology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
  12. 12Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
  1. Correspondence to Else-Mariette van Heijningen, Department of Public Health, Erasmus MC University Medical Centre, P.O. Box 2040, Rotterdam 3000 CA, the Netherlands; e.vanheijningen{at}


Objective To determine adherence to recommended surveillance intervals in clinical practice.

Design 2997 successive patients with a first adenoma diagnosis (57% male, mean age 59 years) from 10 hospitals, who underwent colonoscopy between 1998 and 2002, were identified via Pathologisch Anatomisch Landelijk Geautomatiseerd Archief: Dutch Pathology Registry. Their medical records were reviewed until 1 December 2008. Time to and findings at first surveillance colonoscopy were assessed. A surveillance colonoscopy occurring within ±3 months of a 1-year recommended interval and ±6 months of a recommended interval of 2 years or longer was considered appropriate. The analysis was stratified by period per change in guideline (before 2002: 2–3 years for patients with 1 adenoma, annually otherwise; in 2002: 6 years for 1–2 adenomas, 3 years otherwise). We also assessed differences in adenoma and colorectal cancer recurrence rates by surveillance timing.

Results Surveillance was inappropriate in 76% and 89% of patients diagnosed before 2002 and in 2002, respectively. Patients eligible under the pre-2002 guideline mainly received surveillance too late or were absent (57% of cases). For patients eligible under the 2002 guideline surveillance occurred mainly too early (48%). The rate of advanced neoplasia at surveillance was higher in patients with delayed surveillance compared with those with too early or appropriate timed surveillance (8% vs 4–5%, p<0.01).

Conclusions There is much room for improving surveillance practice. Less than 25% of patients with adenoma receive appropriate surveillance. Such practice seriously hampers the effectiveness and efficiency of surveillance, as too early surveillance poses a considerable burden on available resources while delayed surveillance is associated with an increased rate of advanced adenoma and especially colorectal cancer.


This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.